Surgical Retractors are used to hold an incision or wound open while a surgeon works. The retractor could also be used to hold tissues or organs out of the way during a surgery. 

Self-retaining retractors allow hands free operation during a surgery. Self-retaining surgical retractors like the Galaxy II can be small, such as those for eye procedures, or large, such as table mounted retractor systems. 

Weitlaner and Gelpie Retractors are two of the most commonly used self-retaining retractors for abdominal surgery, but there is also Balfour and Bookwalter Retractors (can be table mounted), as well as Goligher Retractor and Iron Intern.

This instructional video demonstrates set up and utilization of the vaginal self-retaining retractor for pelvic surgery. This includes review of all the component parts, step-by-step assembly, and utilization in different surgical scenarios. This retractor can be easily used with an improved understanding of function and set up; this video aims to aid with both. Utilization of a vaginal retractor facilitates surgical exposure of the pelvis. It also allows the surgeon to operate without reliance on variable surgical assistants. Finally, it promotes surgeon ergonomics.
 

Manual retraction, a task performed to expose the surgical site, poses a high risk for musculoskeletal disorders that affect the hands, arms, shoulders, neck, and back. In recent years, minimally invasive and laparoscopic procedures have led to the development of multifunctional instruments and retractors capable of performing these functions that, in many cases, has eliminated the need for manual retraction. 

During surgical procedures that are not performed endoscopically, the use of self-retaining retractors enables the assistant to handle tissue and use exposure techniques that do not require prolonged manual retraction. 

Tissue Retraction in the Perioperative Setting provides an algorithm for perioperative care providers to determine when and under what circumstances manual retraction of tissue is safe and when the use of a self-retaining retractor should be considered. 

Benefits of surgical self-retaining retractors:

· Surgical retractors free up the hands of an assistant 

· Improved access to surgical site 

· Single handed adjustments (in newer models)

· Less instrument clutter at the incision

· Light-weight and easy to use (newer models)

· Fewer staff in operating room

· Great visual access for students

There is plenty of evidence that fewer staff in the operating room/theatre has a positive effect by reducing infection risk. By replacing the number of individuals close to the open wound, the risk of contamination both from staff to patient as well as from patient to staff is improved. With Covid-19 now present in our every day lives, of course there is now further benefits to using surgical retractors instead of assistants in very close proximity having to lean in close in often awkward positions to assist for long period of times. 

These types of self-retaining retractors have locking mechanisms that keep the blades apart and in place while spreading the edges of the incision and holding other tissue in place, thus freeing the surgeon's and assistant's hands for other tasks. 

Weitlaner and Gelpie

Two of the most commonly used self-retaining retractors are the Weitlaner and Gelpie retractors. These are used to retract skin edges for superficial procedures. Care must be taken not to puncture vital tissues or oneself with the sharp points of these retractors.

Balfour and Bookwalter

The Balfour and the Bookwalter are self-retaining abdominal wall retractors with various deep and shallow blades that can be attached and removed as needed. The Balfour retractor is placed within the incision, spread apart as needed, and locked in place by tightening of a wing nut. The Bookwalter retractor has a single post that attaches to the table's side rail. This attachment takes some practice to master. A crossbar mounted on the post holds an oval or round ring to which various sizes of Richardson, malleable, and Deaver-like blades may be attached with adjustable, ratcheted “clips.”

Goligher and Iron Intern

The Goligher retractor is used for abdominal operations in the superior regions of the peritoneal cavity, particularly for gallbladder, liver, and stomach procedures. It is easily attached to a crossbar placed onto the head of the OR table. The Iron Intern uses a series of locking arms and joints to position retractors within the abdomen or pelvis.

These types are particularly useful in urology, gynecology, ENT, orthopedics, plastic surgery, and many other procedures that need 360 degrees access and vision.

Systems with screw or wire mechanism:

• Lone Star retractor system (single use or reusable frames)
• Wilson retractor 
• Seastar retractor

Systems with new cam lock mechanism:

• Galaxy II™ self-retaining retractor (single use frames)
   

Retractor frames can be re-usable or single use, and are used with single use hooks of different types. The most common hooks are 5mm sharp or blunt hooks or in some cases 12mm blunt hooks for some procedures. 

• No sterilisation cost for single use kits
• Pre-packed, sterile kit
• No need for assistant to retract
• Easily adjusted during surgery leading to reduced operating time
• Less staff cost
• Better ergonomics in the workplace

1. Senn - is a handheld, double-ended retractor used to retract primarily surface tissue. Often used in plastic surgery, small bone and joint procedures, or thyroidectomy and dissection of neck tissue.

2. Army- Navy - Used to retract shallow or superficial incisions. From small wounds to abdominal operations.

3. Ribbon (Malleable) Used to retract deep wounds. May be bent to various shapes to assist in holding back tissue.

4. Hohmann - used in orthopedics to expose bone for procedures.

5. Farabeuf - general use. It is a handheld retractor that is used in multiple procedures. It may be used in dentistry, wrist and hand procedures, or in hernia repair to name a few. We have seen that Galaxy II Snowman can be successfully used in inguinal hernia to reduce number of staff needed. 

6. Meyerding - frequently used to hold back tissue and muscle in spinal and neurosurgical procedures such as laminectomy.

7. Deaver -  used to retract deep abdominal or chest incisions. Used in Cholecystectomy (removal of gallbladder) for retraction of right lobe of liver. Used in Truncal vagotomy (division of the main trunk of the vagus nerve)  for retraction of left lobe of liver. 

8. Richardson - retract abdominal or chest incisions. Used for holding back multiple layers of deep tissue. This is one of the most common general retractors.

1. Weitlaner - It is a popular instrument, most commonly used in basic plastic surgery, large bone and joint procedures.

2. Balfour Abdominal Retractor -  Retract wound edges during deep abdominal procedures.

3. Finochietto Rib Retractor (rib spreader) specifically designed to separate ribs in thoracic surgery. 

4. Hip Retractor system - Millennium surgical has a huge selection of surgical instruments for every specialty. One being the Hip Retractor System. The self retaining hip retractor helps to free assisting personnel while providing excellent exposure during hip arthroplasty and hip fracture surgery.

5. Gelpi - retract shallow incisions. Often used in smaller surgical sites. Common in spine surgery.

Galaxy II can successfully replace most self-retaining retractors, and is suitable also for high-demand retraction (3 finger claw holds up to 30N -- almost triple the force needed in most surgical applications).